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72 Cards in this Set
- Front
- Back
For peripheral vascular disease what are the primary reasons why wounds won't heal
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inadequate vascular supply
Excessive pressure inadequate nutritional support |
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Describe peripheral vascular disease (functional type)
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don't have an organic cause, don't involve defects in blood vessels' structure, usually short term effect related to "spasm" that may comeand go (Raynaud's disease)
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Describe peripheral vascular disease (organic type)
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peripheral vascular diesease are caused by structural changes in the blood vessels (inflammation and tissue damage)
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what is the purpose of lymphatic system
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removes waste/toxins
maintain fluid balance (via transport) |
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what types of patients are at a higher risk for PAD
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<50 with diabetes and one other atherosclerosis risk factor,
50-69 with hx of smoking or diabetes age 70 years and older Leg symptoms with exertion (claudication) or ischemic rest pain abnormal lower extremity pulse examination Known atherosclerotic coronary, carotid, or renal arterial disease |
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What are the symptoms of PAD
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asymptomatic
intermittent (classic) claduication arterial leg symtpoms critical limb ischemia |
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What is intermittent claudication a result of
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result of inadequate arterial bloody supply to the exercising muscles
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what symptoms occur due to intermittent claudication
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aching or cramping in calves that occurs with walking but subsides with rest
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what relieves intermittent claudication
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relieved by standing/dependent position of lower extremities
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How can you bring on the symptoms to confirm intermittent claudication
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elevation will bring on pain because decreases blood flow q
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what are other causes of arterial insufficiency
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acute obstruction
vasospasm vasculitis |
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what is the most precipitating event for arterial ulceration
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trauma
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Clinical features of arterial ulcerations:
Locations |
distalsites; toes, lateral malleolus, dorsal surfaces/exposed to small traumas
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Clinical features of arterial ulcerations:
wound bed and edges |
pale; dry with little drainage
"punched out" clearly defined margins necrosis, eschar or gangerne common poor epithelial migration |
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Clinical features of arterial ulcerations:
pain |
wound site or lower limb
pain elevation of limbs; relief with dependent position intermittent claudication |
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Clinical features of arterial ulcerations:
limb characteristics |
thin with muscle atrophy; pale skin appearance, decrease distal hair growth, thickened toe nails, poor skin turgor, cool to palpation
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Clinical features of arterial ulcerations:
basic clinical test results |
distal pulses are diminished or absent
rubor or dependency (+), capillary refill > 3 seconds venous filling time > 15 seconds ABI: less than or equal to 0.8 |
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What are the diagnostic tests for arterial ulcerations
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ABI and/or toe brachial index (TBI)
Transcutaneous partial pressure of oxygen Segmental doppler ultrasonography duplex doppler imaging angiography |
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what does the following measurement mean for ABI:
>1.30mmHg |
noncompressible
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what does the following measurement mean for ABI:
1.0-1.29mmHg |
normal
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what does the following measurement mean for ABI:
0.91-0.99mmHg |
borderline
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what does the following measurement mean for ABI:
0.41-0.90mmHg |
mild to moderate
(arterial insufficiency, intermittent claudication) |
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what does the following measurement mean for ABI:
0.00-0.40mmHg |
severe PAD
(arterial insufficiency, intermittent claudication) |
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PT examination for arterial ulcer
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wound examination, adjacent skin condition, tests for arterial insufficiency, pain, edema (CHF), sensation (numbness, tingling), ROM of toes, ankle, hip, strength of foot, ankle, knee, hip, footwear, functional mobility, gait analysis
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how do you test claudication time
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1 mile per hour on level treadmill
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what is surgical revascularization
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arterial bypass graft that can happen aortoiliac, aortafemoral, femoropopliteal, femorodistal, balloon angioplasty/endarter ectomy
amputation |
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what are the components of ulcer management
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local wound care
limb protection risk factor reduction |
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When should eschar be debride
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when it is NOT adhered
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How do you handle a wound if you are worried about revascularization
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need to keep the wound dry
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how do you handle a wound if the pt has already had a revascularization
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need to keep moistened.
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PT treatment for arterial ulcer management
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manage ulcer
educate patient/caregivers prescribe progressive walking program |
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Education on skin care
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moisturize dry skin
avoid soaking of feet seek professional help for nail and callus trimming choose appropriate footwear |
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where do you want patients to eventually be with the progressive walking program
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30 min, 3X week, 6months, proven to decrease symptoms of intermittent claudication
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What is chronic venous insufficiency
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occurs because of the inability of the venous system to efficiently return blood to the heart from the lower extremities
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What causes CVI
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sustained venous hyptertension (elevated ambulatory venous pressure)
Increased capillary hydrostatic pressure and permeability resulting from: altered venous return |
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decrease in venus return due to
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increased venous dilation
valvular deficiency muscle pumping |
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When serous fluid protein, fibrin and blood cells move from veins to the tissue what may result
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interstitial edema
brawiness= leakage of protein into interstitial space with resultant fibrosis |
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What causes hemosiderin
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enzymes break down RBS, which causes a brownish-yellow discoloration of tissue
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what can cause high ambulatory pressure
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venous valve incompetence
deep vein obstruction/thrombosis ateriorvenous fistual calf muscle pump failure |
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what are risk factors for venous insufficiency
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a family history of maternal venous insufficiency
a history of DVT, DM, chronic heart failure, or recent edema obesity severe trauma to the leg vigorous exercise number of pregnancies |
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Clinical features of venous ulcerations:
Location |
proximal to medial malleolus (most common)
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Clinical features of venous ulcerations:
wound bed and edges |
shallow, irregularly shaped, erythematous borders, excessive exudate, wound bed can contain fibrous yellow slough
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Clinical features of venous ulcerations:
Pain |
mild to moderate, describe as heaviness or aching.
Worse when standing, relieved with elevation of legs |
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Clinical features of venous ulcerations:
limb characteristics |
edema (hallmark sign)
hemosiderin staining, indurated, dilated superficial veins |
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Clinical features of venous ulcerations:
basic clinical test results |
distal pulse are present
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Why is it important for a PT to know what caused the edema
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The typical treatment for edema is compression. IF the patient has congestive heart failure and you put compression on the extremity, it can make the condition worse
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What are the diagnositc tests for chronic venous insufficiency
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Doppler and Duplex Ultrasound, Contrast Venography
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what are the test and measure for PT Exam
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Wound examination
adjacent skin condition tests for arterial insufficency (-) pain EDEMA** sensation (No major deficiencies) ROM of toes, ankle, knee, hip Footwear functional mobility, gait analysis |
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Management of venous ulcers
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compression is the mainstay of management of venous ulcers
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why is compression the mainstay of dealing with venous ulcer
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compression reduces venous hypertension by blocking transcapillary flow during contraction, thereby increasing the flow out of deep veins
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what are the key components of ulcer management
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local wound care
limb protection risk factor reduction |
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what type of dressing do you use yellow slough
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autolytic debridement with hydrocolloid dressing
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T/F: Ulcers tend to be moist
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True so need to use highly absorbant dressing
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PT treatment for venous ulcer
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mananger ulcer
educate patient/caregivers reduce edema increase aerobic activity |
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Describe the skin care before ulceration generally speaking
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wash intact skin daily with mild soap and water, dry thoroughly, and apply moisturizing cream
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Describe the skin care before ulceration dry skin
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dry, itching skin can be managed by rubbing mineral oil into intact skin, covering with saran wrap to seal in oil, putting on cotton socks and sleeping with it on, removing it in morning followed by washing and drying in the skin well, then applying moisturizing cream. Once a week
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what are the ways you can reduce edema
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exercise (ankle pumps and toe motions)
Elevation (knees higher than hip, ankles higher than knees), 20-30 min 3-4X/day Compression need 40mmHg or ankle graduating to 12-17mmHg at knee |
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How many mmHg does the following provide?
TED hose |
18mmHg
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How many mmHg does the following provide?
Elastic wrap |
24mmHg
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How many mmHg does the following provide?
Support stockings |
30-40mmHg
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Compression support:
Classification I |
mild pressure (15-20 mmHG)
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Compression support:
Classification II |
moderate pressure (20-30 mmHg)
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Compression support:
Classification III |
strong pressure (30-40 mmHg)
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Compression support:
Classification IV |
very strong pressure (>40 mmHg)
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Types of compression bandages
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Non stretch
short stretch long stretch |
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Describe Unna boot
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paste and impregnant with zinc oxide, glycerine, gelatine,calamine
Dries to form a semi-rigid dressing |
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How often do you want to change the Unna boot
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7-10 days
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describe the four layer bandage system
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spirally wrapped orthopedic wool to absorb exudates and protect bony prominences
spirally wrapped cotton crepe bandage highly elastic conformable compression bandage applied to a figure 8 with 50% overlap spirally wrapped elastic cohesive bandage to hold the layers in place |
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T/F: once an ulcer is healed compression is a lifelong daily therapy for individuals with chronic venous insufficiency
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True
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what is the peak pressure of the intermittent compression pump
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45-60mmHg
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how often is the intermitten compression pump used
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1-2hr/twice a day
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what are the contraindications for intermittent compression pump
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arterial insufficiency
edema due to CHF local infection acute thrombophlebitis DVT |